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When communities design broadband infrastructure to facilitate healthcare and telehealth delivery, they obviously plan to connect medical practitioners’ hospitals, offices, and other healthcare facilities. Network connections to homes are growing in importance as government policies and market forces favor telehealth deployments. What about schools and libraries? In many communities, school districts and libraries outperform broadband in people’s homes. For example, the Federal Communications Commission through it its E Rate fund gives schools and libraries hundreds of millions of dollars to build higher speed networks. Subsequently, these institutions often have the fastest broadband connections in the community. Logic and need, therefore, seem to dictate that communities consider telehealth delivery in schools and libraries. School administrators and parents prefer that students, teachers, and parents spend as little time as possible out of school for sickness or traveling to doctors’ offices. Libraries reach out and touch virtually everyone in their communities across the entire economic spectrum. School’s in Session – That’s Where the Need Is The flu was a serious challenge for Sevier County School System in Tennessee that resulted in school closings. “In some winters, the flu could affect as many as 20 percent of 14,000 students, causing entire schools to shut down in an effort to slow the spread of the flu,” explained on Don Best, coordinator of school health for the system. In 2009, the school district turned to telehealth. They use video conferencing hookups and USB compatible devices from AMD Global Telemedicine for quick exams and recording vital signs. Cherokee Health Systems, an area medical practice, is a key element of the telehealth solution. The county also makes sure there is a nurse for every school to assist with the video consult. This partnership allows students to gain access to a higher level of healthcare than what a school nurse is typically able to provide alone. “During the consult, the medical staff can examine the eyes, ears, nose, and throat, as well as listen to the lungs and examine the skin,” said Joel Hornberger, Cherokee Health Systems’ chief strateg officer. With parent’s permission, the staff may also treat minor cuts and abrasions, rashes, strep throat, earaches and flu symptoms, and perform certain lab test. Cherokee Health Systems bills the telehealth services to an insurance carrier or Tennessee’s Medicaid administrator. For those without insurance, Cherokee provides an affordable sliding fee scale for the visit and any necessary lab work. The telehealth system enables the school and Cherokee Health to easily track health and illness trends. Sevier stays with the local medical provider instead of using a national “chain” of telehealth providers that are popular now. Connecting the provider with the schools could result in extra broadband network expenses as the community beefs up or expands the infrastructure, but a local healthcare provider has advantages. “The concern some regulators have is whether a good standard of practice can be achieved for a person with no pre existing relationship with the provider [medical staff], which is often the case for one of these national outfits,” says Frederick Pilot, principal at Pilot Healthcare Strategies. “Or the provider’s inability to get vital signs and gather other information on a patient’s history. “ Besides treating illnesses, telehealth can help maintain a healthy student body. The U.S. Department of Health and Human Services funds in part a telehealth program that helped more than half of obese fifth through eighth graders in the rural Magazine School District reduced their obesity. The program is hosted the University of Arkansas for Medical Sciences (UAMS) Center for Distance Health, and includes three other school districts. When the program began in 2016, 62 students (39 percent) of the 159 students in the targeted grades were categorized as obese based on body mass indexes (BMI). By the end of the program year, 51 percent of those students had a lower BMI.Libraries’ Role in Telehealth Delivery Libraries can team up with healthcare providers to offer health and wellness knowledge as well as telehealth applications and services. Similar to private companies that have healthcare providers schedule on site telehealth services for employees, libraries could explore partnering with innovative medical practices and insurance companies to offer basic services to library patrons. Mobile Beacon has a portable wireless solution that works over the Sprint or T Mobile networks, and serves low income populations. The company sells small, portable wifi transmitters with 8 12 Mbps speed and no data caps, and their main markets are libraries. The libraries loan these devices to their patrons for any time between several weeks to six or 12 months. The company is planning a trial program where these devices are part of a telehealth program. These hotspots and mobile services could fill the gap caused by patrons who don’t have good broadband at their homes, or they can’t afford cellular or broadband services. Surgery patients could borrow a hotspot and telehealth to facilitate recovery and extended home healthcare while the patients get back on their feet. People could use the borrowed hotspots for outpatient rehabilitation and save on travel costs. The potential is there for a myriad of short term telehealth applications. In the future, libraries could become telehealth outposts for traveling nurses. There are 25,000 traveling nurses working for over 340 companies in the U.S. These trained and licensed practitioners take short term assignments in various parts of the country. According to a report issued by Island Health, an authority responsible for providing health services to over 760,000 people on the west coast of British Columbia, “Traveling nurses view telehealth as a tool to better serve clients and wish to integrate telehealth into their practice.” Surveyed Island Health traveling nurses recommend telehealth be adopted into the following programs: pre and post operative consultations, breast feeding assessments, maternal care, pediatric consultations, diabetes group meetings, and respiratory care. In rural America where libraries are the best game in town for getting broadband, conference rooms could become temporary stations for traveling nurses implementing these and other telehealth programs. Additionally, supplying these nurses with mobile hotspots could increase their versatility and effectiveness within the community. Aligning hospitals and healthcare institutions with a community’s schools and libraries into a telehealth center or hub could pay back good dividends. An engineering design team can create a wired and wireless infrastructure that links all three groups into a mini network and add a number of telemedicine applications and services. “These would be a great way to aggregate resources, share network capacity, and lower the cost of participants,” says John Windhausen, executive director of the Schools, Health & Libraries Broadband Coalition. “More communities should pursue these types of consortia, especially in rural areas where telehealth can help to mitigate the damage from rural hospital closures.Craig Settles consults with municipalities and co ops about their broadband networks’ business and marketing plans. His latest report advocates unifying community broadband and telehealth deployments. #tel

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